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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857- V w v,)-e Me-r ;H Wa-` -o'y <br /> PROJECT ADDRESS <br /> t �44 PD Oji/' 1 h�j ✓tlL c/ � Z <br /> Owner Mail Address city State/Zip Phone <br /> Tenant Mail Address City State/Zip Phone <br /> lQ -oU L"i;. �Z�?I L, (16 lift 3 <br /> > (�-!-z' 822 20 I Z <br /> Electrical Contractor Mall Address City State/Zip Phone <br /> 1; ... <br /> State License Number(required) City of Everett Business License Number(required) <br /> 1�9 n rz�nl,('e�ti a Z��} > <br /> Proposed Use of Building Contract Price of Work <br /> T!-G"'yT itj)tJ ,v w Lj NV-,G;,,,,N <br /> Square Footage (If residential new construction, remodel or addition) Contact Person/Contact Number/Email <br /> Number of devices (If low voltage) <br /> Description of Work to Be Done: A". J-j C2-t: `/ 5-'q1 i r✓ tZ r'Ir'�<1G�Y�l u t��7•� <br /> i <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 E*50cOl hereby certify that I have read and examined this application and know the same to be true and _1 <br /> correct. All provisions of laws and ordinances governing this type of work will be completed <br /> whether specified herein or not. The granting of a permit does not presume to give authority to PERMIT# <br /> violate or cancel the provisions of any other state or local law regulating construction or the <br /> performance of construction. That/am authorized by the owner of this property to perform the ) <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and �� I <br /> 296.200 WAC. <br /> ;1 <br /> Signature I G i <br /> Date <br /> REVISED 0610612014 •G` 76 6(f p-I <br />